In FNA(+) group, the number of patients who underwent thyroid operation increased in all sub-groups including nodules ≥ 10mm, nodules 5mm-10mm and nodules ≤ 5mm. In nodules ≥ 10mm sub-group, the growth was steady and slow, in the other sub-groups, the growth were rapidly especially in 2012. But in 2016, there was a significant decrease in nodules ≤ 5mm sub-group. In no FNA biopsy group, number of patients who underwent thyroid operation decreased in all sub-groups. In nodules ≥ 10mm sub-group, the decrease was not obvious. In the other two sub-groups, the decrease were distinct. (Fig. 1)
In FNA(+) group, the increment speed of the amount of thyroid operation in different sub-groups was different. The nodule was more smaller, the increment speed increased more faster. In nodules ≥ 10mm sub-group, the average increment speed was 4.59%. In the first two years except 2011, the fixed base relative increased more obvious. Since 2014, the fixed base relative tend to be stable. The link relative ratio fluctuated in the up and down 10%, but the growth showed a rising tendency overall. In nodules 5mm-10mm sub-group, the average increment speed was 44.65%. The fixed base relative had an average increasing. The link relative ratio had an outbreak in 2012, and was stable over the next few years. In nodules ≤ 5mm sub-group, the average increment speed was 57.76%. The fixed base relative increased every year. The link relative ratio had an obvious increasing in 2012, and remained stable until there was a significant reduction in 2016. (Table. 1)
In no FNA biopsy group, the number of patients with smaller nodules decreased faster. If the tumor was malignant after surgery, the average increment speed was − 3.90%, -19.35% and − 33.54% respectively in nodules ≥ 10mm sub-group, nodules 5mm-10mm sub-group and nodules ≤ 5mm sub-group. If the tumor was benign after surgery, the average increment speed was − 21.00%, -38.10% and − 100.00% respectively in nodules ≥ 10mm sub-group, nodules 5mm-10mm sub-group and nodules ≤ 5mm sub-group. The overall average increment speed was − 4.42%, -20.50% and − 34.93% respectively in nodules ≥ 10mm sub-group, nodules 5mm-10mm sub-group and nodules ≤ 5mm sub-group. The change was not obvious in nodules ≥ 10mm sub-group, but tremendous in both nodules 5mm-10mm sub-group and nodules ≤ 5mm sub-group no matter the nodules were malignant or benign. (Table 2–4).
Table 2
Nodule: No FNA & TI-RADS IVa-V (malignant)
Variable
|
≥ 10mm
|
increment speed
|
5mm-10mm
|
increment speed
|
≤ 5mm
|
increment speed
|
Total
|
increment speed
|
|
cancer
|
fixed basis
|
link-relative method
|
cancer
|
fixed basis
|
link-relative method
|
cancer
|
fixed basis
|
link-relative method
|
cancer
|
fixed basis
|
link-relative method
|
2011
|
582
|
——
|
——
|
211
|
——
|
——
|
54
|
——
|
——
|
847
|
——
|
——
|
2012
|
505
|
-13.23%
|
-13.23%
|
165
|
-21.80%
|
-21.80%
|
32
|
-40.74%
|
-40.74%
|
702
|
-17.12%
|
-17.12%
|
2013
|
488
|
-16.15%
|
-3.37%
|
127
|
-39.81%
|
-23.03%
|
15
|
-72.22%
|
-53.13%
|
630
|
-25.62%
|
-10.26%
|
2014
|
491
|
-15.64%
|
0.61%
|
118
|
-44.08%
|
-7.09%
|
16
|
-70.37%
|
6.67%
|
625
|
-26.21%
|
-0.79%
|
2015
|
455
|
-21.82%
|
-7.33%
|
89
|
-57.82%
|
-24.58%
|
5
|
-90.74%
|
-68.75%
|
549
|
-35.18%
|
-12.16%
|
2016
|
477
|
-18.04%
|
4.84%
|
72
|
-65.88%
|
-19.10%
|
7
|
-87.04%
|
40.00%
|
556
|
-34.36%
|
1.28%
|
total
|
2998
|
|
|
782
|
|
|
129
|
|
|
3909
|
|
|
average increment speed
|
-3.90%
|
-19.35%
|
-33.54%
|
-8.07%
|
In no FNA group, the average increment speed in different sub-groups was different. If the tumor was malignant after surgery, the nodule was more smaller and the increment speed decreased more faster after ultrasound indicating TI-RADS IVa-V. |
Table 4
Nodule: No FNA & TI-RADS IVa-V (Surgery both malignant and benign)
Variable
|
≥ 10mm
|
increment speed
|
5mm-10mm
|
increment speed
|
≤ 5mm
|
increment speed
|
Total
|
increment speed
|
|
surgery
|
fixed basis
|
link-relative method
|
surgery
|
fixed basis
|
link-relative method
|
surgery
|
fixed basis
|
link-relative method
|
surgery
|
fixed basis
|
link-relative method
|
2011
|
608
|
——
|
——
|
233
|
——
|
——
|
60
|
——
|
——
|
901
|
——
|
——
|
2012
|
523
|
-13.98%
|
-13.98%
|
176
|
-24.46%
|
-24.46%
|
34
|
-43.33%
|
-43.33%
|
733
|
-18.65%
|
-18.65%
|
2013
|
497
|
-18.26%
|
-4.97%
|
129
|
-44.64%
|
-26.70%
|
16
|
-73.33%
|
-52.94%
|
642
|
-28.75%
|
-12.41%
|
2014
|
502
|
-17.43%
|
1.01%
|
120
|
-48.50%
|
-6.98%
|
16
|
-73.33%
|
0.00%
|
638
|
-29.19%
|
-0.62%
|
2015
|
461
|
-24.18%
|
-8.17%
|
90
|
-61.37%
|
-25.00%
|
5
|
-91.67%
|
-68.75%
|
556
|
-38.29%
|
-12.85%
|
2016
|
485
|
-20.23%
|
5.21%
|
74
|
-68.24%
|
-17.78%
|
7
|
-88.33%
|
40.00%
|
573
|
-36.40%
|
3.06%
|
total
|
3076
|
|
|
822
|
|
|
138
|
|
|
4043
|
|
|
average
increment speed
|
-4.42%
|
-20.50%
|
-34.93%
|
-8.65%
|
In no FNA group, the increment speed decreased not obvious in nodules ≥ 10mm sub-group, but tremendous in both nodules 5mm-10mm sub-group and nodules ≤ 5mm sub-group no matter the nodules were malignant or benign. |
If all malignant thyroid tumor with surgery put in one panel from 2011 to 2016, the total operation number increased, but operation of patients with nodules ≥ 10mm decreased slightly and operation of patients with nodules < 10mm increased markedly especially in nodules ≤ 5mm sub-group. The average increment speed was − 0.83%, 9.33% and 23.91% respectively in nodules ≥ 10mm sub-group, nodules 5mm-10mm sub-group and nodules ≤ 5mm sub-group. (Table 5).
Table 5
No. of malignant tumor surgery: both FNA(+) and without FNA
Variable
|
≥ 10mm
|
increment speed
|
5mm-10mm
|
increment speed
|
≤ 5mm
|
increment speed
|
Total
|
increment speed
|
|
surgery
|
fixed basis
|
link-relative method
|
surgery
|
fixed basis
|
link-relative method
|
surgery
|
fixed basis
|
link-relative method
|
surgery
|
fixed basis
|
link-relative method
|
2011
|
860
|
——
|
——
|
265
|
——
|
——
|
76
|
——
|
——
|
1201
|
——
|
——
|
2012
|
809
|
-5.93%
|
-5.93%
|
417
|
57.36%
|
57.36%
|
119
|
56.58%
|
56.58%
|
1345
|
11.99%
|
11.99%
|
2013
|
814
|
-5.35%
|
0.62%
|
425
|
60.38%
|
1.92%
|
162
|
113.16%
|
36.13%
|
1401
|
16.65%
|
4.16%
|
2014
|
846
|
-1.63%
|
3.93%
|
419
|
58.11%
|
-1.41%
|
201
|
164.47%
|
24.07%
|
1466
|
22.06%
|
4.64%
|
2015
|
799
|
-7.09%
|
-5.56%
|
408
|
53.96%
|
-2.63%
|
271
|
256.58%
|
34.83%
|
1478
|
23.06%
|
0.82%
|
2016
|
825
|
-4.07%
|
3.25%
|
414
|
56.23%
|
1.47%
|
222
|
192.11%
|
-18.08%
|
1461
|
21.65%
|
-1.15%
|
total
|
4953
|
|
|
2348
|
|
|
1051
|
|
|
8352
|
|
|
average increment speed
|
-0.83%
|
9.33%
|
23.91%
|
4.00%
|
Over the six years, the total operation number increased, but operation of patients with nodules ≥ 10mm decreased slightly and operation of patients with nodules < 10mm increased markedly especially in nodules ≤ 5mm sub-group. |
Table 6
No. of surgery patients without FNA but ultrasound showed TI-RADS IVa-V.
Variable
|
Nodule: No FNA & TI-RADS IVa-V (Surgery)
|
≥ 10mm
|
5mm-10mm
|
≤ 5mm
|
Total
|
cancer
|
benign
|
cancer
|
benign
|
cancer
|
benign
|
cancer
|
benign
|
2011
|
582
|
26
|
211
|
22
|
54
|
6
|
847
|
54
|
2012
|
505
|
18
|
165
|
11
|
32
|
2
|
702
|
31
|
2013
|
488
|
9
|
127
|
2
|
15
|
1
|
630
|
12
|
2014
|
491
|
11
|
118
|
2
|
16
|
0
|
625
|
13
|
2015
|
455
|
6
|
89
|
1
|
5
|
0
|
549
|
7
|
2016
|
477
|
8
|
72
|
2
|
7
|
0
|
556
|
17
|
total
|
2998
|
78
|
782
|
40
|
129
|
9
|
3909
|
134
|
Comparison of benign and malignant differences between different size nodules after operation |
In no FNA biopsy group, to compare the malignancy or benign tumor after surgery between nodules 5mm-10mm sub-group and nodules ≥ 10mm sub-group, χ2 = 12.000,P = 0.001, and between nodules ≤ 5mm sub-group and nodules ≥ 10mm sub-group, χ2 = 7.968༌P = 0.005, but between nodules 5mm-10mm sub-group and nodules ≤ 5mm sub-group, χ2 = 0.669༌P = 0.414. Further pairwise comparison showed, in nodules 5mm-10mm sub-group and nodules ≤ 5mm sub-group, the probability of benign tumor was greater than nodules ≥ 10mm sub-group. (Table. 6).